Just the thought of negotiating an employment agreement can be quite intimidating for many physicians - particularly if it’s your first position coming out of residency or fellowship training. Fears of tension-filled, adversarial negotiations with a significantly more experienced physician or executive sitting across the table are prevalent, as are fears of overstepping one’s bounds and potentially losing the offer. These fears often lead to many physicians simply signing the contract as is, with no attempt at negotiating better terms.
The reality is that negotiations are rarely contentious, and you can inquire about improved terms with minimal risk of the offer being pulled. Entering negotiations with that mindset, along with possessing a basic understanding of the process, will have you more than prepared to tackle this not-so-daunting (yet very important) task.
Refrain from any negotiations until you have received the actual offer. Initiate this conversation too early, and you run the risk of coming across as being too aggressive or money motivated if negotiating compensation - traits that could deter an employer from seriously considering you. An employer is more invested in you after an offer is extended and potentially more likely to make concessions in order to "get the deal done." Thus, your leverage and ability to negotiate are greater at that point than they were early in the interview process.
The answer to this question requires self-reflection. Will you be able to clearly articulate any desired changes and stand firm on requests if necessary without becoming too emotionally involved? If the answer is questionable, then it may be in your best interest to consider using an attorney for negotiation assistance.
You will find that most attorneys who offer contract review services also offer some form of negotiation assistance. Some will offer to speak with the prospective employer directly to negotiate on your behalf, while others may provide you with their suggested revisions and then it is up to you to communicate the requests on your own. Ask about these services in your initial attorney selection process. But in the end, do not be worried about inserting an attorney into the process. You’re reviewing a legal document that was written by an attorney to protect the employer’s interests. You should be doing the same.
Knowledge of what contractual items are actually negotiable is paramount. Though most physician contracts are similar nationwide from a structural standpoint, there are some key provisions and terms that vary by organization and affect the overall quality of the offer.
Compensation is commonly at the forefront, as those are more easily recognizable items that tend to vary the most from organization to organization. However, do not overlook the many other variables that may also be negotiable. Those could include call expectations, paid time off (PTO) and research/administrative time. Lastly, are you protected should this position not work out for whatever reason? Is the termination and non-compete language fair and equitable? Will the provided malpractice insurance require you to purchase tail coverage upon departure, and is that something for which you’re prepared?
Your approach can dictate how receptive the employer will be during negotiations. If you’re concerned about losing an offer, you can be extremely soft in your negotiations and simply pose your requests as "would you consider…" type questions. That allows the employer the opportunity to simply say "no" without you being too aggressive and risking an offer being pulled - but at least you asked the question.
On the opposite end of the spectrum, there may be items that would lead you to turning down the offer if they are not changed. In that scenario, your ability to walk away from the offer allows you to be the most aggressive. Either way, it is important that you also learn as much as you can about the prospective employer’s process in order to adequately assess your leverage and ability to negotiate. For example, are you the only candidate they are interviewing, or do they have multiple candidates they are considering for this opening? As you can guess, you are taking more risk in being too aggressive in negotiations if they can easily move on to another candidate. Ensure your negotiations will make a long-term relationship a favorable prospect for all.
For compensation specifically, surveys from the Medical Management Group Association (MGMA), the American Medical Group Association (AMGA) and Sullivan Cotter can provide you with market data relevant to your specialty and practice location.
An attorney skilled in reviewing physician contracts can also help you determine if an offer is acceptable. In addition, there is great benefit in going on multiple interviews and collecting multiple offers. Doing so enables you to make an informed decision while comparing compensation, clauses and language throughout your ultimate negotiation.
Jeff Hinds, MHA, is president at Premier Physician Agency, LLC, a national consulting firm specializing in personalized physician job search and contract assistance.